1. Sleep Apnoea – a growing health problem
John Stradling MD FRCP
Emeritus Professor of Respiratory Medicine
Oxford University

2. Covering today: What is OSA? How prevalent is it? Consequences
individuals and society
Treatment options
Areas of particular concern

3. What is OSA?
Failure of the upper airway to stay open when its muscles relax during sleep
50 seconds
Airflow in and out the nose and mouth stops, but the subject goes on struggling to breathe

4. Repeatedly disrupts the normal breathing pattern (often
Repeatedly disrupts the normal breathing pattern (often hundreds of times a night)
Each apnoea causes the body to briefly wake up to restore normal breathing
Prevents a person from having a good night’s rest and causes excessive daytime sleepiness
Increases the likelihood of falling asleep driving
Is nearly always accompanied by loud snoring
Often goes undiagnosed as the
individual is usually not
aware of repeatedly waking up
Severe OSA, when daytime sleepiness
is present, is known as
OSA Syndrome (OSAS)

5. Sleep laboratory recording of obstructive sleep apnoea

6. How Prevalent is Obstructive Sleep Apnoea?
Depends on definition – thresholds and exact components
Depends on levels of obesity
In the UK approximately 1-2% of adults have severe OSA worthy of CPAP treatment – the Oxford sleep clinic has over 11,000 patients on treatment (CPAP)
In the UK approximately 5-10% of HGV drivers have significant OSA likely to be increasing their degree of sleepiness
In certain populations, e.g. type II diabetics, the prevalence is much higher
In a snorers the prevalence of severe OSA is much higher
In Western Samoa – obesity is a sign of status and there is an enormous problem of obesity

7. Why worry about it? Impact of untreated OSAS
Untreated – sleepiness due to OSA can severely impair driving, anyone who gets behind the wheel of a vehicle has a higher risk of having an accident – between 3 and 9 times ‘normal’
Any accident is likely to be more severe due to failure to correct errors quickly
Accidents involving HGVs particularly bad

8. Falling asleep at the wheel
(without a seat belt)

9. Other effects of OSA on health
Untreated, OSA can be dangerous to health – increased risk of high blood pressure, heart problems and stroke, and is associated with type 2 diabetes and depression
It can have a major impact on quality of life and relationships with family and friends
Is thought to reduce life expectancy by up to 20%
But if a patient is compliant with treatment, he or she can lead a normal life and drive as safely as any other driver on the road.

10. Who is a typical OSA patient?
Usually, but not exclusively, men – tend to be middle-aged
Often over-weight with a 17 inch collar or higher
Commercial drivers are more likely to have OSA due to sedentary lifestyle
Irregular shift patterns exacerbate the sleepiness
Usually have loud snoring and pauses in breath while sleeping, noticed by a bed partner
Other signs are difficulty in concentrating, and falling asleep when watching TV, in meetings, and drowsiness while driving
But not all individuals with OSA are sleepy

11. Benefits of treatment
Patients often report feeling as though they have had a new lease of life!
Feel more refreshed and able to enjoy a better quality of life
Relationships improve as sleep patterns normalise
Overall improvements to health means the patient feels better and is much less likely to take sick days
Concentration and motivation in the workplace improve
Safety behind the wheel – likelihood of having an road traffic accident returns to normal

12. Treatment
The most common treatment for OSA is continuous positive airway pressure (CPAP)
Very effective
Rapid results, often after first treatment night
NICE approved (TA139, 2008 & 2012)

13. Areas of particular concern
OSA is a particularly common condition amongst middle-aged men in the UK - especially those who are overweight (over-represented among HGV drivers).
Drivers with OSA and sleepiness (OSAS) are three to nine times more likely to have an accident, and the impact of the accident is more likely to be severe - causing immense damage, personal injury and deaths.
Professional drivers are usually reluctant to come forward with symptoms which they fear may lead to losing their livelihood.
Such drivers will only come forward if rapid diagnosis and treatment can be guaranteed

14. Four Week Wait campaign – improving treatment
Four Week Wait campaign – improving treatment access for professional drivers
NICE Clinical Knowledge Summary advises GPs to fast track drivers who are worried about losing their licence
The Newcastle Freeman Hospital has run a pilot which has demonstrated that it is possible to easily introduce a fast tracking programme
DVLA have changed their requirements to be less draconian following representations from us.
BUT
NICE ‘Clinical Guidelines and Practice Standards’ promised, but publication 2+ years away

15. Conclusions
Obstructive sleep apnoea (OSA) is common, with many adverse consequences to the sufferer and others
OSA is on the increase, mainly due to the rising BMI in the population
OSA is under-recognised and needs greater awareness
In those who develop consequential sleepiness, driving is an important issue, especially for professional drivers
Until services for professional drivers are guaranteed, we will have such drivers still on the roads